How To Support Someone with Hyperemesis Gravidarum

This guide is to help family members and friends be of assistance to a woman suffering from hyperemesis gravidarum. Your support is essential to her coping and recovery from this often debilitating illness.

A pregnant woman with HG, and her family and friends, need to be flexible and sympathetic, especially with regard to diet. Her food cravings might be complex or strange and her whole life might become centered around food. She might have cravings for a short time, which need to be fulfilled as soon as possible, or cravings which last longer or repeat frequently. The main goal is to increase her intake of nutrients and fluid in any way you can.

Creating a network of support is vital and this support is to help with all aspects of daily life, to provide tolerable foods and minimize stress levels. Any stress, whether physical, mental or emotional, can worsen her condition and make her feel guilty about the extra work and responsibility she feels she is creating for those around her.

It is important to be aware of the triggers and keep her environment free of them if at all possible. Not every woman suffering from HG will have all the following triggers but it is common to experience most or nearly all of these:

• Noise (kids playing, TV) whether ongoing or sudden sounds
• Having an empty stomach even though she might not feel hungry
• Bright lights or blinking ones
• Toothpaste, mouthwash and other hygiene products (soap, deodorant etc)
• Stimulating her gag reflex (such as having to swallow a pill or sip a drink)
• Vitamin and mineral supplements (especially ones containing iron)
• Having to sit upright, stand or lie in a certain position
• Any kind of motion, even slight ones like having to sit up or walk
• The sight, thought or smell of food (other people eating near her, food on the TV or in magazines etc)
• Traveling in any kind of vehicle
• Pressure on her stomach, even light
• Any smells, including ones that aren't especially strong (oil, paper, furniture polish – anything)
  

Be aware that she might need to sleep by herself. Because of her heightened sense of smell, she will be able to smell food on your breath and skin. This is a hormonal reaction and you should not take it personally. Remember it is only temporary. She might be strongly affected by motion and will not be able to manage even a daily shower. You should be understanding about this and remember that it is not her choice.

It is important to know what might make her feel blameworthy, nervous, unhappy or angry and try to resolve or minimize the influence of these elements. These are some of the factors which might make her feel the above negative emotions:

• The desire to eat and drink normally which for her is not possibly.
• Inability to prepare for the baby's birth, having to rely on others to do this
• Not being able to think clearly or partial memory loss
• Missing months of work or having to quit her job altogether
• Missing out on the fun of being pregnant as most women seem to enjoy
• Taking medications which might be risky to her or the baby
• Lack of understanding and support from other people
• Putting her life on hold for months on end and not knowing when the suffering will end
• Not being able to look after the family and home and guilt because of this
• Fear of a difficult birth or even losing the baby as a result of the HG
• Fear of death or serious illness worse than what she has
• Burden of care and time from friends, family members and health professionals
• Not being able to spend time with other people and being totally isolated when symptoms bad
• Amount of money spent on support and care for her condition
• Inability to eat well or take vitamins to improve her health and strength
• Not experiencing a normal pregnancy like other women seem to manage
• Fear of not being able to bond properly with the baby after it is born
• Severe fatigue and loss of energy, not being able to do anything, feeling useless
• Sense of failure and inadequacy at not being able to function or cope with everyday tasks and expectations
• Giving up hope that nausea will stop before arrival of baby
• Others wrongly thinking HG is only in her mind and not realizing the extent of her suffering
• Thoughts of terminating the pregnancy to end her misery and guilt stemming from this
• Dreading the recovery time, not knowing how long it will be before feeling normal
• Lack of energy for the kids and inability to play with them or spend time with them
• Worry about weight loss or not enough gain for the baby's gestational age
• Not wanting to accept medical treatments because of the cost or liability
• Fear of being force fed or having to have painful treatments before or after the birth
• No excitement about the upcoming birth, just wanting it to be over so she can feel normal again
• Fluctuating emotions because of illness and hormones, fear of not being able to control them
• Fear of this happening again if she gets pregnant again in the future

Allow her to do whatever she needs to cope. Tell her it is OK to rest and listen to the needs of her body. She should feel no guilt at having to quit her job or take extended leave if her symptoms are very bad. Try to avoid any major stresses like moving house until she has recovered from the HG and from the birth. Read as much as you can about the symptoms and treatments.

It is a good idea to make a list of ways in which others can help and let them choose how they want to help out, picking from tasks which suit their schedule and skills. Women are unlikely to ask for help when needed so it is best to let the volunteers arrange a good time but not ask the woman with HG whether the help is necessary. Assume she needs the help but fears being a burden.

If you only have limited support, you might want to hire a "doula" which is a supportive companion (other than a loved one or friend). A doula is professionally trained and can provide support during the pregnancy, birth and afterwards. This an include care of mothers and newborns, breastfeeding assistance and advice, child care, cooking, errands and light housework for the family.

Try to arrange for somebody to visit daily to avoid isolation or depression.

Give her as many choices possible to decrease any feelings of dependency or helplessness.

You should be her advocate, especially when it comes to medical care. She will probably have difficulty in being assertive or thinking in a clear way because of metabolic imbalances. If you feel that her treatments are not working, feel free to seek other medical help or change doctors. Before she has a GTT (glucose tolerance test) you might want to discuss the use of jelly beans or apple juice (instead of Glucola) with a health professional. Women with HG often cannot tolerate Glucola so the apple juice or jelly beans might give better results. You might want to buy Ketostix, which are sticks you dip in urine to test for Ketones, which indicate starvation, dehydration and the possible need for IV hydration.

As soon as she feels she is able to eat something, prepare it. Liquid meals which are high in nutrients can be a good choice. Fresh fruit juice, vegetable juice or protein powders are healthy. You might want to try the "baby shake" which is an adaptation of the "pregnancy cocktail", devised by Fred Rohe in The Complete Book of Natural Foods.

If you can afford it, hire cooking, cleaning and childcare services to give her time to rest. Continue this after the birth until she is better. It can take several months for her to heal completely, especially if her HG lasts into late pregnancy. This is a short period and you should help as much as possible. Don't use foods or cleaning products with strong odors. Accept all her offers for help until the smell bothers her. Tell others about her intolerable foods and request they eat away from her.

Try to understand her need (even after the birth) to talk about her HG experience and recover at her own pace. She will be upset that she missed the pregnancy and will have to heal emotionally as well as physically. If she is severely depressed (unable to care for herself or the family) or anxious, seek medical help. Don't let her struggle emotionally or physically.

Remember that she was sick for six to nine months and it will take perhaps this long again to recover fully from the illness. Be patient with her and help out as much as you can.